What to know about the Affordable Care Act's open enrollment period now underway

People heading into the Affordable Care Act open enrollment period with plans to sign up for insurance should expect a variety of changes in 2027, including higher premiums and fewer coverage options.

The sign-up window for the marketplace, also known as Obamacare, starts Sunday in most states and runs through Jan. 15.

Big changes to the exchange include expiring financial assistance, rising rates, potential delays in working with a broker, new restrictions on immigrants, and stricter enrollment checks.

Financial help, including premium tax credits and cost-sharing reductions, is now restricted for many groups of people who were previously eligible.

Across the board, healthcare experts predict less coverage and higher prices, with the average price of health insurance purchased through the marketplaces expected to rise by 13% in 2027, according to analysis of new CMS data by the healthcare research nonprofit KFF.

Increases are driven by multiple factors

Cynthia Cox, a vice president and director of the ACA program at KFF, said the increase is primarily driven by rising healthcare costs, hospital market concentration, and potential factors such as the No Surprises Act, which took effect in 2022 and bans surprise billing, or the rising availability of GLP-1 drugs.

The people who will be most affected by the new increases are those who do not qualify for a subsidy.

“They may or may not be able to afford to continue to keep their coverage into next year,” Cox said, adding that “a lot of them have already moved into bronze plans, which are the cheapest plans."

A CMS fact sheet about open enrollment that was distributed Friday says “Americans using HealthCare.gov will have robust access to low-cost plans.”

The price of ACA insurance has skyrocketed for many people during Trump’s second term after Republicans opposed extending COVID-era subsidies that had helped offset the costs of health insurance for most enrollees during Democratic President Joe Biden’s administration.

That resulted in 1.2 million fewer people signing up for coverage in the exchanges.

Nearly 20 million people in US are actively enrolled in ACA plans

As of February, roughly 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services website. The number of enrollees grew during the COVID-19 pandemic when enhanced subsidies became available through the American Rescue Plan Act and Inflation Reduction Act, both signed into law by Biden.

New regulations starting in 2027 will also limit tax credits for certain lawfully present immigrants, which could result in an additional 1 million uninsured individuals over time.

Meanwhile, the Trump administration has been removing ACA enrollees from the program as part of the ongoing campaign against what it characterizes as waste, fraud and abuse.

In September, Vice President JD Vance and other officials in the Republican administration announced plans to remove 760,000 ACA enrollees from public healthcare exchanges, alleging the individuals were fraudulently enrolled in the program or simply did not exist.

Vance said the discovery and canceled subsidy payments for hundreds of thousands of people from the exchanges, part of an administration-wide crackdown on fraud, would result in $2.2 billion in cost savings.

It's unclear how many more people will drop off of ACA coverage in 2027, Cox said. But with higher premiums, immigration eligibility changes and the anti-fraud efforts, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why.”